title: Inpatient care for children, ages 1-20 years, with spina bifida in the United States.
abstract: OBJECTIVE
  To describe the inpatient health service use and insurance types for hospitalized children with spina bifida compared to children generally and to evaluate hospital discharge and insurance type trends over a 10-year study period.
  
  
  METHODS
  The cross-sectional secondary data analyses were conducted using the 2000, 2003, 2006 and 2009 Kid's Inpatient Databases. Diagnoses were identified by ICD-9 codes and hospital type was categorized based on the National Association of Children's Hospitals and Related Institutions designations. Chi-squared tests and the Wald test of trend were used for the statistical analyses.
  
  
  RESULTS
  Children with spina bifida are more likely to receive their inpatient care in children's hospitals or pediatric units compared to all children. Children with spina bifida were most commonly admitted for shunt malfunction and repair. The percentage of children covered by Medicaid rose during the study period for both children with spina bifida and children generally.
  
  
  CONCLUSIONS
  This study is the first of its kind to document longitudinal trends in inpatient utilization, insurance type, and reason for admission for children with spina bifida. The changing trends in insurance coverage should be closely monitored because insurance is closely linked to health care access, which is linked to health outcomes.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA. houtrow@upmc.edu.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Houtrow
authors.forename: Judith H
authors.initials: JH
authors.lastname: Maselli
authors.forename: Megumi J
authors.initials: MJ
authors.lastname: Okumura
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000639:trends*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006760:Hospitalization / Q000191:economics / Q000639:trends*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000639:trends*; D008137:Longitudinal Studies; D010351:Patient Discharge / Q000639:trends*; D016135:Spinal Dysraphism / Q000191:economics / Q000628:therapy*; D014481:United States; D055815:Young Adult